Gingivoplasty and Gingivectomy| Gums Gingival Tissue Therapy

Gingivoplasty and Gingivectomy| Gums Gingival Tissue Therapy

Gingivoplasty is an operation to correct the volume and contour of the gums in cases when the gingival tissue swoops over the teeth or, on the contrary, does not cover the periodontal pockets.

Most often, gingivoplasty of the gums is a cosmetic nature and is needed in situations where the gum drops slightly and exposes the root of the tooth, or, on the contrary, rises too much on the tooth. In both situations, the intervention allows you to restore the aesthetics of the smile.

Gingivoplasty can also be carried out for medical reasons, for example, when the tooth root is exposed. exposed tooth root cause severe discomfort to cold and hot sensation and is much prone to decay and abrasion. Gingivoplasty can be done don to restore gingival tissues on tooth root and restore protection. The operation is one of the simplest dental procedures, therefore, it is performed under local anesthesia.

Gingivoplasty is an operation on the soft tissues (mucous membrane) of the oral cavity in the gum region, which is performed when the qualitative or quantitative characteristics of the gums around the teeth or implants are violated.

Gingivoplasty is a microsurgical procedure, ie. surgical shaping of soft healthy tissues (gums) around the tooth . It belongs to periodontology , although today it is increasingly used in cosmetic dentistry.

Gingival tissue is removed if:
Periodontal pockets form between the teeth and gums in which food and bacteria accumulate.
There is excess gum around the tooth.

In the most severe cases, excess gums can cause difficulty in chewing food, but also in speech, so this is a good reason for gingivoplasty.

Gingival tissue structure

Normally, the gum consists of a fixed (attached keratinized gingiva) and a movable part. In the area next to the teeth, it is motionless, fused with the periosteum, adheres tightly to the bone and necks of the teeth, does not form pockets and does not bleed, and has a pale pink tint.

Thanks to the attached gum, we can safely chew solid food, while not injuring the gums, brush our teeth with a brush and not experience pain. Slightly below the motionless keratinized gum turns into a mobile one. Here it is brighter, redder. And if you pull on the lip or cheek, then the movable gum will move just to the line of transition to the fixed one, which is fused with the periosteum.

In terms of quantitative characteristics, the gums can be thin, medium and thick. The quantitative characteristics of the gums are called gingival biotype.

Gingivoplasty is necessary if:
The gums are too mobile around the teeth.
Tissues atrophied and gum recession occurred.
There is an excess of gum tissue due to under-teething.

The purpose of this surgical manipulation is to restore the quality and quantity of gum tissue, i.e. change in the biotype of the gums.

Difference between gingivectomy and gingivoplasty

There are two periodontal surgeries with very similar names - gingivectomy and gingivoplasty.
Gingivectomy surgically removes gum tissue (gingiva) , such as in the most severe cases mentioned when the patient has difficulty in chewing food or speaking.

Gingivectomy can be used to treat gingival hyperplasia. It's also used to remove extra gum growth for cosmetic reasons, such as to improve a smile.

Gingivoplasty is the surgical shaping of healthy gum tissue.

We must note that neither of the two procedures penetrates the bone and does not remove the bone.

Gingivoplasty is most often performed independently of gingivectomy, but can be performed before or after gingivectomy.

IS GINGIVECTOMY PAINFUL?

Gingivectomy is performed under local anesthesia and is completely painless. It can be done classically with a scapel but also with a laser. Depending on how many gingivas we need to remove, sometimes it is necessary to combine these two methods to get a satisfactory effect.

WHEN IS GINGIVECTOMY PERFORMED?

Gingivectomy is most often used for aesthetic reasons, ie to solve the problem of gummy smile, ie. too visible gums when smiling. We also use gingivectomy during the treatment of periodontitis as part of lobe surgery.

Indications for gingivoplasty

The indications for this manipulation can be roughly divided into cosmetic and medical. Often, even small aesthetic problems at the initial stage are enough to carry out gingivoplasty for prophylaxis and prevent the appearance of medical problems in the future.

Cosmetic indications

Under-teething, especially with a high smile line. Due to under-eruption of teeth, the gum is at the level of the coronal part and hides part of the length of the teeth. And when a person smiles, the teeth look short, and the contour of the gums becomes visible.

Gum recession. These are pathological changes in the gum tissue, in which the contour of the gums is lifted, and the root of the tooth is exposed.

The zeniths of the teeth (the place where the tooth passes into the gum) have a semicircular shape and on symmetrical teeth should be the same, and the general line of the zeniths should be at the same level.

In a recession, the gum rises higher, exposing the root of the tooth, and the zeniths become asymmetrical.

A wedge-shaped defect is a common pathology that develops when a toothbrush is used incorrectly. A wedge-shaped defect is usually associated with gum recession. In a recession, the root of the tooth is exposed, and the toothbrush, if used incorrectly (moving horizontally to the right and left), erases the dentin. A wedge-shaped defect appears on the neck and root of the tooth.

Medical indications

Most often, patients come to the dental clinic with aesthetic problems, however, medical indications are often added to them:

In case of violation of the quality and quantity of the gums, it is impossible to maintain adequate hygiene, and pathogenic microflora enters the tooth ligaments or bone tissue (in the area of ​​the implant), causing inflammation.

With recessions of the gums, the roots of the teeth not covered with enamel appear hypersensitive: they begin to react with soreness to temperature and taste stimuli.

Dental implantation in 98% of cases is accompanied by gingivoplasty. On the day of implantation, additional gum volume is created. And after 3 months, if necessary, the resulting mobility of the gums in the implantation zone is eliminated. Soft tissue implantation provides a good prognosis for decades. Gum grafting is also performed after bone grafting.

How is the operation of gingivoplasty carrieed out?

The procedure takes place on an outpatient basis under local anesthesia. Modern anesthetics allow you to completely anesthetize both the donor and the recipient area (where the graft is transplanted).

In some cases (stomatophobia, unwillingness to "be present" at one's own operation, a large amount of intervention), for greater comfort, the dentists suggest performing the operation under sedation.

In 95% and more cases, the patient's own tissues are used for this manipulation. Donor zones are:
The tubercle of the upper jaw. There are many collagen fibers in the tissues of this area, taking the graft from the tubercle area and further healing is almost painless.

Palate (used less often when there is a lack of tissue). Healing takes place more slowly, and the patient may experience discomfort while eating or talking for 1-2 days after the intervention.

Retromolar space(area behind the lower teeth). It is used very rarely, because collagen-rich tissue is less common in this area.

Donor zones are selected depending on:
Type of manipulation
The volume of suitable tissue in donor areas.

In the most extreme cases (lack of tissue as a result of previous operations or anatomically atrophic tissues, patient refusal to injure the palate), artificial materials (for example, artificial collagen) are used for gingivoplasty.

Operation technique

The tactics of conducting a surgical intervention directly depends on the diagnosis.
The tactic of operations is to prepare the recipient site in advance, i.e. the place where you want to transfer the graft from the donor area. A soft-tissue pocket or tunnel is created with an ophthalmic or dental scalpel, special tunnel raspatory. Then, a free connective tissue graft is taken from the donor area (from the tubercle of the upper jaw or from the palate).

Methodology

In the case of gingival recession plasty or an increase in gingival volume (build-up), the graft is de-epithelized in the area of ​​the implants, i.e. the layer of the integumentary epithelium is removed from the graft, and it is inserted into a pocket or tunnel.

If the task is to create an attached keratinized gingiva , then the graft is fixed in the recipient zone without de-epithelialization.

There are also different methods of graft collection - it depends on the thickness of the donor zone and the tasks set. Then the wound surfaces are sutured - donor and recipient areas.

With gingivoplasty, in case of under-eruption of teeth, excision of the marginal gum (which hides the tooth) is carried out taking into account the height of the coronal part of the teeth.

The duration of the procedure depends on the amount of intervention (from 1 to several hours). If the volume is very large, then the manipulation is divided into several stages. For example, the operation is performed first on the right side, then on the left.

This allows the patient to chew food calmly, not to experience discomfort and to maintain a high quality of life during the rehabilitation phase.

What you need to know about the postoperative period

Usually, rehabilitation takes 1-2 days, when the patient may experience discomfort and mild pain. Much depends on the individual characteristics and adherence to the doctor's recommendations.

Full recovery will take 3 months: during this time, molecular bonds and blood supply in the tissues are restored.

In order for the healing to take place as quickly and painlessly as possible, it is necessary to strictly follow the doctor's recommendations and until the moment of epithelialization:

Don't eat tough food.
Exclude spicy, salty, sour from the diet.
Give up alcohol and smoking.
Observe gentle hygiene.
This is a common set of restrictions that must be followed after any oral surgery.

Contraindications for gingivoplasty

Contraindications for gingivoplasty are exactly the same as for any other operation:
Uncompensated chronic diseases: tuberculosis, pyelonephritis, liver cirrhosis, diabetes mellitus, etc.
Diseases of the blood.
Drug and alcohol addiction.
Oncological diseases.
Pregnancy.
Heavy smoking patients (1.5-2 packs per day), due to impaired blood supply to the gums For gingivoplasty, blood supply is the first condition to be considered.

However, if all these chronic diseases are compensated and are under the supervision of a specialist, then, under certain conditions, you can go for gum surgery.

What the patient will receive as a result of gingivoplasty

With gingivoplasty we get both an aesthetic effect and prevention of wedge-shaped defects. At the same time, pain sensitivity to thermal and gustatory stimuli is eliminated - to cold and hot food, to spicy, salty, sour. Compliance with self-hygiene by patients is greatly facilitated.

When performing gingivoplasty, or it is also called perioplasty, in the area of ​​implantation, due to the thickening of the gum around the implant and obtaining an attached keratinized gum, self-hygiene is facilitated and improved, the blood supply to the bone tissue around the implant is improved, which is the key to the long-term service of the implant.

In the case of gingivoplasty, in the case of incomplete teeth, the patient receives a high aesthetic result. Gingivoplasty is an extreme method of dental restoration. It is performed not only to cleanse the base of the teeth, but also to correct the location of the detached gums. This procedure significantly improves the aesthetic appeal.

Service cost

What are the benefits of gingivoplasty?

Health

Gingivoplasty gives the gums a completely natural look. It corrects malformations and asymmetries caused by genetic factors . But today it is very often used exclusively for cosmetic purposes in cosmetic dentistry.

When used for periodontal purposes, it is performed to treat periodontal disease.

Periodontal pockets are being repaired - dangerous hotspots where bacteria accumulate. Here, its purpose is primarily health.

Aesthetics

In cosmetic dentistry, the contours of the gingiva are improved, creating harmony between the gingival line and the crown of the tooth.

Gingivoplasty is thus part of the DIGITAL SMILE DESIGN, which in the projection of a new smile outlines a new line of smile and gingival level.

The so-called gummy smile the “red-white” relationship is disrupted. The smile line is too high, so too much gums can be seen when talking or laughing . With this procedure, we successfully solve this aesthetic problem that disturbs the self-confidence of many people, so they rarely laugh.

How long does it take from gingivectomy / gingivoplasty to be able to take an impression for ceramic crowns or veneers?

If a small part of the gingiva is removed up to approximately 1 mm, then it does not require reshaping the jawbone around the tooth and the intervention can only be reported with a laser.

In that case, the print can be taken in just a few days and sometimes on the same day. However, if it is necessary to remove more gingiva, this entails the obligatory remodeling of the jawbone around the tooth.

Then, during the intervention, the classic flap must be removed, and one must wait a month to take prints for crowns or veneers.

If a larger amount of gums is removed and the jawbone is not remodeled, after a few months the gums would return to their original position and we would not get the desired result.

When is gingivectomy performed and when is gingivoplasty performed?

Laser gingivectomy is most often used for congenital anomalies of high gums (so-called gummy smile). A common aesthetic problem in many patients. This procedure was previously intended for the treatment of periodontal diseases, while today it is also used as a cosmetic surgical technique.

Gingivoplasty is used in patients who have an unusually shaped or excessive gingiva.
The causes can be:
genetic,
disease or
trauma.
Gingivoplasty is most often performed to make the gums look nicer and better.

Can gums grow back after Gingivectomy?

Gingivectomy is the resection of the enlarged portion of gums due to certain diseases. Gums do not grow back after gingivectomy, however for healthy gums proper Oral hygiene is mandatory.


References

Den Tim


Practicing Dentistry for 20 years